Klebsiella invasive syndrome: a challenging diagnosis

Abstract

Klebsiella invasive syndrome is a rare condition that typically presents as a liver abscess with metastatic infection, with mortality rates as high as 14% potentially due to diagnostic delay by clinicians. Here, we present a case of a woman in her 60s, who presented with symptoms and signs consistent with meningitis, imaging findings suggestive of possible leptomeningeal carcinomatosis a long with areas of lung consolidation and abdominal nodules and lymphadenopathy, presumably metastatic malignancy. We diagnosed Klebsiella invasive syndrome and treated it conservatively with medical management, including a long course of intravenous antibiotic therapy and supportive care. This is an infrequently encountered clinical entity with potentially fatal consequences, and we hope to add to the existing literature on the subject and drive home the point that it should be considered in the differential diagnoses in the appropriate clinical scenario.

Demographics and prognosis of patients with pyogenic liver abscess due to Klebsiella pneumonia or other species

“…Several other studies of PLA patients also found that a positive blood culture was an independent risk factor for primary treatment failure [ 11 , 29 ]. It is likely that PLA patients with concomitant bloodstream infections have greatly weakened immunity, a condition that can aggravate PLA and possibly lead to invasive liver abscess syndrome, with infections of other organ systems, including meningitis, endophthalmitis, necrotizing fasciitis, and lung abscess [ 30 , 31 ]. The strain of KP responsible for PLA may also affect primary treatment failure [ 6 ].…”

Elevated 68Ga-FAPI Activity in Klebsiella pneumoniae Invasion Syndrome

“…Early diagnosis and lesion detection can reduce mortality. 5 Imaging of isolated liver abscess lesions in 18 F-FDG PET/CT has been reported in the past. [6][7][8] Increased 68 Ga-FAPI activity has been previously reported in different infectious diseases including syphilis, 9 organizing pneumonia, 10 tuberculosis, 11 and cryptococcus.…”

“…So, it is easy to miss early identification. Early diagnosis and lesion detection can reduce mortality 5 . Imaging of isolated liver abscess lesions in 18 F-FDG PET/CT has been reported in the past 6–8 .…”